Saturday, December 31, 2011

2011 Births: A Doula's Year in Review

I seriously doubt a new baby will eke its way into the world out of one of my clients within the next few hours (though anything is possible), so I thought I'd look through my birth notes of this year to see what's cooking in terms of the efficacy of the work of doulas.

This year I attended quite a few births less than I do on average. The grand total was 37 births. My goal was to cut it down to 30, but it's SO hard for me to say "no" to my repeat clients. I took off most of April, all of July, half of October, and only took on one birth for December. So given I was actually off call for a good 10 weeks to teach or go on vacation, it still was a decent amount of births.

I had a higher than usual amount of "out of hospital" births with midwives (six). Out of the nine planned, two transferred to the hospital in late labour for medical intervention (one a first time mom, and one a second, both for vacuum extraction after prolonged second stage), and one was risked out of her desired midwife attended birth and medically induced because of pre-eclampsia (all gave birth without epidural).

Four of my clients gave birth by Cesarean. One was planned due to a breech baby and large uterine fibroids. One was an emergency with the baby during second stage (all worked out fine in the end). One was a mom who had wanted a VBAC, but developed an infection just prior to labour, and another was a long Cervidil/Synto induction for post dates which ended up simply not progressing after a very long and heroic attempt. All moms and babies are doing just great.

Nine of my total number of 37 clients received epidurals, for all reasons ranging from personal preference (yes, doulas DO take clients who know from the get go they WILL take an epidural no matter what...we are all for informed choice) to very long, difficult labours in which the choice to take an epidural greatly helped the mom's experience.

11 of the ladies who did not receive epidurals were first time birthers, and three out of these were medically induced (one with Cervidil, which produced a baby super fast, and 2 with Synto). One induced with castor oil at 2 weeks post dates. (Nine of these un-epiduraled births took place in a hospital setting ).

13 of the ladies who birthed without epidural were having second or third babies. One was induced simply by having her waters broken.

Out of the ladies who did receive an epidural, (one first time and one second time birther), two were long, exhausting inductions.

Two of the 37 births were VBACs (which is a low amount for my usual total). A third was an attempted VBAC, but the mom birthed by Cesarean again.

So in terms of percentages:

Cesareans: 10.8% This is less than half of our provincial average.

Epidurals: 24% In Montreal, overall epidural use is about 80% (this is not including my mothers who had Cesareans...they only took epidurals very close to their surgeries.

Because "natural" birth can mean many things, to clarify, because I work with a mainly hospital birth population, I call a "natural" birth one in which there was no epidural or Cesarean. This can include induction, episiotomy, vacuum extraction, whatever. Yes, I know, purists would take great issue with this, but if a woman is able to go into a hospital and have an induction and perhaps vaccuum extraction and can pull this off without an epidural, darn right we'll let her claim natural birth. What are you gonna say to a lady who has a 48 hour labour and ends up with a vacuum extraction as her only intervention? Sorry, Dude, no natural birth for you? Nope. Everything is relative. I hesitate to use the term "normal" birth for all these births, though, as most births I see in hospital settings are not normal by virtue of the hoops women are asked to jump through even when they might not want to, hoops that can be antithetical to the physiological process of birth (lying on back, being tethered to an external fetal monitor, being engaged intellectually during contractions, directed during pushing, her environment outside of her control, etc.) But this does not mean women don't have GREAT births in the hospital much of the time and are very happy with their experience, even if they were not "normal" or "natural". So, yeah, I say natural when there's no epidural. Period.

And the rate of moms having a natural birth:
64.9%

The most hands off birth I saw this year, meaning the baby was literally only caught once in mid-air because she insisted upon not being touched, the room was nearly silent, the mom was left to pick up her own baby instead of her thrown into her arms (the mom was on her hands and knees and the baby was scootched between her legs up to where mom could look at and take her when she was ready), the cord was left for a good 15 minutes, no perineal checks, "massage" of the uterus, or management (besides quiet, respectful vigilance)until after the placenta was born, and no routine Synto, was not where you would expect. This birth took place in a hospital with a nurse and an obstetrician who were both SO happy to serve the woman in this way. I wanted to weep with the hope of possibility.

My stats also consistently illustrate that epidurals don't necessarily always go hand in hand with inductions, depending on the type of induction.

While many of my clients came to me wanting a natural birth, many of those who were not sure what they would choose in the moment DID end up having a natural birth. And several who KNEW they wanted a natural birth, did NOT have one for varying reasons.

The shortest labours this year were about 1.5 hours from the time contractions were noticeable. (one was a first time mom)

The longest was about 50 hours (first time mom), about 36 of those hours having contractions strong enough to make her vocalize.

The biggest baby was 10.5 pounds, born at the Maison de Naissance to a first time mom in about four or five hours of labour with a WONDERFUL, skilled midwife who knew to keep the oxytocin flowing by keeping Mom calm and focused when the shoulders proved to be quite jammed. She never screamed (PUSH, THIS IS SERIOUS!), because fear and arenaline tend to have the opposite effect on what needs to be done by the mom. It was a brilliant and enlightened approach.

Thank you, all my wonderful clients and babies, for allowing me the honour of attending your births! You are all rock stars of the highest degree. And thanks to all the caregivers who did great jobs in keeping the birthings safe and the environment pleasant. Blessings to all for a wonderful New Year!